Autologous Blood Injection to Treat Achilles Tendinopathy? A Randomized Controlled Trial

Context: Achilles tendinopathy is a common and often debilitating condition, and autologous blood injection is a promising treatment option. Objective: To determine whether autologous blood injection added to standard management was effective in alleviating symptoms of Achilles tendinopathy. Design: A prospective randomized controlled trial. Setting: Private sports medicine clinic. Patients: 33 patients (18 women, 15 men) of mean age 50 y (SD 9) with 40 cases of Achilles tendinopathy of mean duration of 11 mo (SD 7). Intervention: Participants were randomized to blind peritendinous autologous blood injection added to standard treatment (eccentric-loading exercises) or standard treatment alone for 12 wk. Main Outcome Measure: Victorian Institute of Sport Assessment for Achilles (VISA-A) score and ratings of discomfort during and after the injection were measured at baseline and 6 and 12 wk. Analytically derived effect-size thresholds of 5 (small) and 15 (moderate) VISA-A units were used as the reference values for clinical inference. Results: Improvements in VISA-A of 7.7 units (95%CL: +/- 6.7) and 8.7 units (+/- 8.8) were observed in the treatment and control groups, respectively, at 6 wk relative to baseline, with no clear effect of blood injection. At 12 wk VISA-A score improved to 18.9 units (+/- 7.4) in the treatment group, revealing a blood-injection effect of 9.6 units (+/- 11.5), relative to a comparatively unchanged condition in control (9.4 units; +/- 9.0). Predictors of response to treatment were unremarkable, and a 21% rate of postinjection flare was the only noteworthy side effect. Conclusions: There is some evidence for small short-term symptomatic improvements with the addition of autologous blood injection to standard treatment for Achilles tendinopathy, although double-blinded studies with longer follow-up and larger sample size are required.